August 2008 — Vol. 3, No. 8
In This Issue
- Understanding the Policy Side of eHealth
Neal Neuberger - More on the Institute for e-Health Policy
- Know the Tele-Definitions and Differences
- Online Doctors Make House Calls Again
Rob Varnon - Telehealth Technology Offers Value to Patient Care
- Join the HIMSS Ambulatory Roundtable
- News Briefs
- States and Health IT Webinar Series
- Already There…Adopted Healthcare IT
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Digital Office is a monthly online newsletter published by the Healthcare
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Vice President, Healthcare Information Systems, HIMSS
For more information on the HIMSS ambulatory initiative,
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Special Issue - Telemedicine
Understanding the Policy Side of eHealth
Neal Neuberger
An interview with Neal Neuberger, executive director of the Institute for eHealth Policy
For more than 20 years Neal Neuberger has been involved in policy-related, telehealth activities, expertise that led to his role as the Executive Director of the Institute for e-Health Policy, launched in June by the HIMSS Foundation. He is also immediate past Secretary of the American Telemedicine Association and current Chair of the Policy Committee for the ATA.
“We have a long road ahead to have telehealth recognized as a lot of us think it should be.” Mr. Neuberger cites the need for reimbursement in the public sector, such as Medicare and Medicaid, and in the private sector with coverage by health insurance companies.
Licensing for physicians and nurses represents a major hurdle for delivery of patient care via telemedicine due to state licensing laws. Both doctors and nurses receive state-based licenses. For nurses, some states recognize reciprocity, which allows nurses to cross state lines to deliver care. Physicians do not have this option. Thus, for both doctors and nurses, the states retain control over who practices within the state's boundaries, including those engaged in telephone triage or virtual practice and monitoring. Find out more on reciprocity for nurses.
“If you are licensed as a physician in one state, you cannot, with any sense of comfort, treat someone across state lines,” he explains. “That changes somewhat if you have state reciprocity in neighboring states.” Thus, the real issue for telemedicine and eHealth depends on the nature of the consults because clinicians cannot practice or prescribe medicine across state lines. As Mr. Neuberger notes, “At the end of the day, it should not matter where the patient nor the clinician is located.within the United States”
Other Issues to Consider: As interest grows in telehealth as a care delivery method, the healthcare industry also faces several hurdles. They include:
- Privacy and security
- Licensure of clinicians
- Accreditation of clinicians
- EMR and telehealth liability
- Prohibition on physician self-referrals
- Regulation by FDA of software (will it be similar to medical devices?)
- Rural and underserved populations
“Incentives are not aligned to cause a small group of two to four physicians or an urgent care center to implement an EMR. It’s a disruptive technology and costs a lot of money. For them (the physicians in small practices) to take this on, we had better address that issue.” He suggests addressing the tax code through deductibility for equipment purchase and reimbursement through insurance policies.
With lower costs and greater sophistication in technology, the implementation comfort level is rising. “We have seen incremental changes because people are adopting new health IT systems despite the barriers.”
More on the Institute for e-Health Policy
Transforming federal and state policy into everyday practice
As Executive Director of the Institute for eHealth Policy, Neal Neuberger will continue the collaborative effort established in 1993 with the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics. Supported by 25 organizations that focus on different aspects of telehealth issues, the Steering Committee demonstrates that groups can work together to support certain issues for each organization. Since its formation, the Steering Committee has held 120 programs with more than 500 speakers as part of its luncheon series. Luncheon attendance ranged from 70 to 100 attendees.
The Institute also will focus on the disparities in health IT implementation with emphasis on quality care access for the disadvantaged urban and minority populations. For example, broadband is not equally available in many communities, said Mr. Neuberger. How will the lack of this technology affect these groups? Will health IT tools be available to address the needs of the un- and under-insured? With assistance from interns from Georgetown University Medical Center, the Institute will work with other organizations to help find the answers to these questions and more.
“The HIMSS Foundation helps bring the needed resources for the Institute’s activities,” said Mr. Neuberger, “and provide visibility here in Washington, D.C.”
Read the news release for more information on the Institute for eHealth Policy.
Neal Neuberger, president of Health Tech Strategies, LLC, in McLean, Va., is the Executive Director of the Institute for eHealth Policy, launched by the HIMSS Foundation. A former Legislative Assistant to U.S. Rep. David R. Obey (D-WI) on the House Appropriations Subcommittee on Labor, Health and Human Services, Mr. Neuberger is well known inside the Capitol Beltway and on Capitol Hill. He will continue to lead the Capitol Hill Steering Committee for Telehealth and Healthcare Informatics.
Know the Tele-Definitions and Differences
This issue of the Digital Office looks at telemedicine, a word often used synonymously with telehealth…or not? What is e-health? Are all of these words the same?
See the definitions that follow from the HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations (HIMSS 2006) to clarify what these words mean.
e-health – eHealth (also written e-health) is a term for healthcare practice which is supported by electronic processes and communication; some people would argue the term is interchangeable with ‘health informatics.’ However, the term ‘e-health’ encompasses a whole range of services that is at the edge of medicine/healthcare and information technology, including electronic medical records, telemedicine, and evidence-based medicine.
Telehealth – Using communications networks to provide health services including, but not limited to, direct care, health prevention, consulting, and home visits to patients in a geographical location different than the provider of these services. Any delivery of health services to a client in a geographical location different than that of the provider.
Telemedicine – Part of telehealth that is defined as a health professional in one location using electronic technologies for the diagnosis and/or treatment of a patient in another location.
Telenursing – Practice of nursing over distance using telecommunications technology
Online Doctors Make House Calls Again
Find out the benefits - and challenges - of telemedicine in an online article from the Connecticut Post (Fairfield County-Bridgeport) that appeared in the Aug. 22 edition of eHealth Smart Brief. More doctors are treating patients over the Internet, according to a study from the National Center for Policy Analysis. How does telemedicine affect malpractice insurance rates, treating patients across state lines, and providing patient-specific medical advice online? To read the article, Sign up for a free subscription to eHealth SmartBrief. Then, access the archived Aug. 22 edition to read this article.
Telehealth Technology Offers Value to Patient Care
Learn more about the value proposition for telehealth in The Value of Provider-to-Provider Telehealth Technologies, a report from the Center for Information Technology Leadership (CITL). Information on the CITL Web site notes that this research examines “the value proposition for implementing a subset of telehealth technologies: those in which providers are involved in both the near, or patient side, and the far side of the encounter.”
The report looks at three types of telehealth technology systems:
- Store-and-forward
- Real-time video
- Hybrid model combing the first two
These technologies are reviewed in four healthcare settings, such as reducing transfers from the emergency department, and transfers to the emergency department and physician offices from correctional facilities and from nursing homes. How best to replace in-person consults with virtual consults and reduce unnecessary and redundant laboratory tests are also included in this review.
As for cost-effectiveness, the report projects that the hybrid model of telemedicine offered the best return-on-investment. Findings include:
- Savings of $3.61 billion each year with reduction of in-person care visits and unnecessary and redundant laboratory tests
- Savings of $192 million annually on mileage expense for the 142 million annual referral visits in the United States
- Savings of $4.28 billion each year with nationwide implementation of hybrid telemedicine systems
Visit http://www.citl.org/ to download the complimentary report.
Visit the HIMSS Store to order the printed report, which is complimentary with a $7 shipping charge.
Join the HIMSS Ambulatory Roundtable
Be part of the HIMSS Ambulatory Roundtable to discuss and learn about emerging and current issues and trends in the ambulatory care setting, specifically addressing the adoption and use of health information technology. This forum is a new, exclusive benefit for the Corporate and Organizational Affiliate members of HIMSS and will provide an opportunity to network within the HIMSS ambulatory community.
Discussions will focus on health IT in the ambulatory setting and offer opportunities to confer with others who have the same focus. As an important part of HIMSS strategy, the Roundtable will provide HIMSS updates on ambulatory health IT policy and legislation with the opportunity for feedback on direction and strategies. The group meets monthly on the second Wednesday of each month from 1-2 p.m. EST.
Contact Jill Redenius to join the Ambulatory Roundtable or for more information. For other volunteer opportunities in ambulatory care initiatives, visit HIMSS online.
News Briefs
Incentive Payments for Physician Group Practice Demo: On Aug. 14, the Centers for Medicare & Medicaid Services (CMS) announced that the 10 physician groups participating in the Physician Group Practice (PGP) Demonstration improved the care provided to patients (with congestive heart failure, coronary artery disease and diabetes mellitus) during performance year 2 of the demonstration. As a result, CMS reports that the 10 physician groups earned $16.7 million in incentive payments. Read the press release.
Doctors Should Use EMRs: A recent survey from Harris Interactive found that nearly 90 percent of respondents said they want their physicians to transition to a digital format to share medical information. Another 71 percent want their prescriptions via ePrescribing. As for patients using the same online approach to managing their healthcare, less than half of the respondents would access their medical information online, if available (44 percent) or make appointments and email their physician (48 percent). Conducted in May, the survey tracked results from 1,000 participants.
Homecare Nurses Rely on Telehomecare System: The Central Coast Visiting Nurse Association and Hospice in Monterey, Calif., (CCVNA) has found that it can stretch the resources of the homecare nurses while providing better case management by using a telehomecare system. Read more.
Telemedicine – What Does the Future Hold? Each month, the HIMSS online survey Vantage Point asks healthcare professionals their opinions on relevant industry topics. The August survey covered Telemedicine, per the headline that appears with this article. The results were not available for this edition of the Digital Office. But, find out what industry professionals who responded to this survey said by visiting the HIMSS Web site in early September.
Share Your Opinion on Proposed Adoption of ICD-10 Code Sets
On Aug. 15, HHS announced a long-awaited proposed regulation to replace the ICD-9-CM code sets now used to report healthcare diagnoses and procedures with greatly expanded ICD-10 code sets, effective Oct. 1, 2011. In a separate proposed regulation, HHS has proposed adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as healthcare claims. Version 5010 is essential to use of the ICD-10 codes.
The proposed changes aimed at improving disease tracking and speeding transition to an electronic healthcare environment apply to health plans, healthcare clearinghouses, and healthcare providers who transmit any electronic health information in connection with a transaction for which a standard has been adopted by HHS.
View the ICD-10 code sets proposed rule and the updated transaction standards proposed rule. Fact sheets describing both proposed rules will be forthcoming. Comments on both proposed rules are due by 5 p.m. EDT on Oct. 21.
HIMSS will be facilitating a response to these proposed regulations. Those interested in participating in this effort can contact Holly Gaebel, coordinator, healthcare information systems.
States and Health IT Webinar Series
This series of webinars will discuss the role of health IT in transforming health care. Health IT is a key component of state efforts to improve quality and reduce costs in health care. Learn about state financing efforts, e-prescribing and accountability in the digital age. This series is part of NCSL's work with the State Alliance for e-Health.
Registration is free. Click here or see more information below.
E-prescribing: A Path Forward for e-Health?
Wednesday, Aug. 27 @ 2-3:30 p.m. EDT
What is e-prescribing? Why should state policy makers care about it? How can state policymakers influence its use and adoption? This webinar will provide an introduction to e-prescribing and the policy challenges facing it. The State Alliance will discuss its efforts to drive the use of e-prescribing. In addition, Tennessee will discuss their efforts to advance e-prescribing.
- Mark Gorden, Director of Policy, eHealth Initiative
- Senator Richard Moore, MA
- Melissa E. Hargiss, Interim Director of eHealth Initiatives
Accountability in Health as We Enter the Digital Age
Wednesday, Sept. 10 @ 2-3:30 p.m. EDT
As the health sector continues its slow march into the electronic age, many new questions arise for state legislators. To realize the full benefit of electronic records, a robust system for the exchange of electronic patient data will have to be established. What will the state role be in establishing and supporting organization that facilitate health information exchange? How will states structure oversight models for these new entities?
- Shaun Alfreds, Senior Project Director, University of Massachusetts Medical School Center for Health Policy and Research
- Rachel Block, Executive Director, NY eHealth Collaborative
- Amy Zimmerman, Chief, HIE Project, Rhode Island Department of Health (Invited)
Already There…Adopted Healthcare IT
Primary Care Associates Ends Paper Chase with EHR
Solution pays for itself two months following implementation
By Alan L. Tannenbaum, MD
Internist and Founder of Primary Care Associates
Cape Coral, Fla.
After six years, our medical practice of five dedicated physicians—who treat between 150 and 175 patients daily—had grown weary documenting on paper. In 2001, we made a life-changing decision to join the paperless world by deploying MediNotes Corporation’s electronic health record (EHR) solution, MediNotes e.
Today, Primary Care Associates, an internal and family medicine practice employing 27 staff members at two offices in Cape Coral and Fort Myers, Fla., is operating much more efficiently—eliminating the burdens of paper overload.